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RENAL HEMANGIOMACase ReportInternational Braz J UrolOfficial Journal of the Brazilian Society of Urology

Vol. 30 (3): 216-218, May - June, 2004

RENAL HEMANGIOMA

THEODORICO F. DA COSTA NETO, JUAN M. RENTERIA, G. DI BIASE FILHO

Section of Urology, Ipanema General Hospital, Rio de Janeiro, RJ, Brazil

ABSTRACT

Introduction: Renal hemangioma is a relatively rare benign tumor, seldom diagnosed as acause of hematuria.Case report: A female 40-year old patient presented with continuous gross hematuria, anemia andepisodic right lumbar pain, with onset about 3 months previously. The patient underwent multipleblood transfusions during her hospital stay and extensive imaging propedeutics was performed. Semi-rigid ureterorenoscopy evidenced a bleeding focus in the upper calix of the right kidney, with endo-scopic treatment being unfeasible.

The patient underwent right upper pole nephrectomy and presented a favorable outcome.Histopathological analysis of the surgical specimen showed that it was a renal hemangioma.

Comments: Imaging methods usually employed for diagnostic investigation of hematuria donot have good sensitivity for renal hemangioma. However, they are important to exclude the most fre-quent differential diagnoses. The ureterorenoscopy is the diagnostic method of choice and endoscopictreatment can be feasible when the lesion is accessible and electrocautery or laser are available. Weemphasize the open surgical treatment as a therapeutic option upon failure of less invasive methods.

Key words: kidney; hemangioma; hematuriaInt Braz J Urol. 2004; 30: 216-8

INTRODUCTION

Renal hemangioma is a relatively rare benigntumor, seldom diagnosed as a cause of hematuria.Approximately 200 cases were reported since thiscondition was first described by Virchow in 1867 (1).This tumor can be classified as cavernous or capil-lary and the majority of lesions have a diameter ofless than 1 cm. It affects most frequently young adultsand there is no preference for gender.

Clinical presentation is characterized by he-maturia ranging from intermittent microscopic hem-orrhage to abundant, continuous bleeding, with he-modynamic repercussion.

We report one case of gross hematuria due torenal hemangioma emphasizing clinical presentation,imaging diagnosis and the treatment prescribed.

CASE REPORT

Female, 40-year old patient, complained ofepisodic gross hematuria with onset around 4 yearspreviously, which became continuous and associatedwith episodic right lumbar pain in the past 3 months.

On the physical examination, gross hematuriaand anemia were evident. The patient underwent anultrasonography of the urinary tract, excretory urog-raphy and abdominal and pelvic computerized tomog-raphy that did not evidence significant alterations. Thesemi-rigid ureterorenoscopy showed a bleeding fo-cus in the upper calix of the right kidney, with endo-scopic treatment being impossible due to difficultyof access. Renal arteriography was performed, show-ing no alteration (Figure-1). The patient maintainedactive bleeding, leading to persistent anemia and re-

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quiring multiple blood transfusions during hospital-ization. Renal arteriography was unable to evidencethe bleeding focus. However, considering its previ-ous location on semi-rigid ureterorenoscopy, an op-tion was made towards selective embolization of theright kidney upper pole (Figure-2).

Since there was no hematuria remission fol-lowing arterial embolization, the patient underwent aright upper pole nephrectomy (Figure-3), presentinga favorable outcome, without hematuria within a 6-month follow-up. Histopathological analysis revealedrenal hemangioma.

COMMENTS

Renal hemangioma is seldom diagnosed as acause of hematuria. Imaging examinations usually arenot helpful for diagnosing hemangioma, though theyare important in order to exclude more frequent causesof hematuria.

The differential diagnosis of renal heman-gioma must include papillary necrosis, ectopic pa-

Figure 1 – Right selective renal arteriography, without identify-ing the bleeding focus.

Figure 2 – Right renal arteriography following selective embo-lization of the upper pole (arrow).

Figure 3 – The macroscopic surgical specimen revealed a lesionmeasuring approximately 0.5 cm in the upper calix of the rightkidney (arrow).

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pilla, hemorrhagic papillitis and urothelial carcinoma,among others (2).

Currently, the flexible ureterorenoscopy is themethod of choice for diagnosing this kind of lesion(3). When available, the electrocautery or laser con-stitutes also the treatment of choice, if the lesion isaccessible. However, in the absence of such facili-ties, open surgery is indicated in cases of persistentbleeding.

REFERENCES

1. Daneshmand S, Huffman JL: Endoscopic managementof renal hemangioma. J Urol. 2002; 167: 488-9.

2. Viguier JL, Abbar M, Gelet A, Bouvier R, Martin X,Marechal JM, et al.: The contribution of endoscopy inthe diagnosis of unilateral hematuria of renal originand pseudotumors of the upper urinary tract. Prog Urol.1994; 4: 219-27.

3. Tawfiek ER, Bagley DH: Ureteroscopic evaluation andtreatment of chronic unilateral hematuria. J Urol. 1998;160: 700-2.

Received: November 25, 2003Accepted after revision: January 28, 2004

Correspondence address:Dr. Juan Miguel RenteriaHospital Geral de IpanemaRua Antônio Parreiras, 67 / 69Rio de Janeiro, RJ, 22411–020, BrazilFax: + 55 21 3111-2362E-mail: jm_renteria@yahoo.com.br